Intra‐arterial embolization of lumbar artery pseudoaneurysm following percutaneous nephrolithotomy

The management of a patient with haematuria following percutaneous nephrolithotomy is described. The patient underwent renal angiography to assess the cause of bleeding. A pseudoaneurysm arising from first left lumbar artery was incidentally discovered, which was then successfully embolized using an indigenously fabricated metallic coil and gel foam particles in the same sitting.     

Histiocytic sarcoma: PET-CT evaluation of a rare entity

Histiocytic sarcoma is a rare malignancy of hematopoietic origin. Lymph nodes, skin, and extranodal sites, especially gastrointestinal tract, are commonly involved. Some cases reported in the past as non-Hodgkin’s lymphoma are now classifi ed as histiocytic sarcoma by detailed immunohistochemical studies. Patients with clinically localized disease have a good prognosis whereas those with lymphatic involvement have an aggressive course. In our case, histiocytic sarcoma was detected, originating from the skin over the left shoulder associated with disseminated lymphadenopathy. A positron emission tomography/computed tomography examination was done for evaluating the extent of the disease which showed pathologic increased 18F-fl uorodeoxyglucose uptake in the lymph nodes, indicating widespread disease. The pertinent literature is reviewed.     

In vivo confocal microscopy findings in a patient with posterior amorphous corneal dystrophy

A 21-year-old man, with bilateral posterior amorphous corneal dystrophy, was studied by biomicroscopy, corneal topography and in vivo confocal microscopy. The best-corrected visual acuity was 6/21 in the right eye and 6/6.9 in the left eye. Biomicroscopy revealed bilateral, asymmetric, sheet-like opacification at the deep posterior stromal layer. The corneal topography displayed asymmetric against-the-rule astigmatism in the right eye and prominent steepening at the inferior paracentral cornea in both eyes. In vivo confocal microscopy of the corneas demonstrated microfolds and hyper-reflective layer at the posterior stroma just adjacent to the endothelial layer. The epithelium, Bowman's membrane, anterior stroma and the endothelial layer were normal. In vivo confocal microscopy is useful in evaluating the corneal dystrophies.     

Successful transcatheter balloon dilatation of coarctation of aorta and coil occlusion of patent ductus arteriosus in a single catheterization procedure

Simultaneous transcatheter coil occlusion of patent ductus arteriosus and balloon angioplasty of coarctation of aorta is avoided since intimal tearing after angioplasty is believed to increase the risk for dissection of the aorta during catheter manipulation. We report a 14-month-old boy, with weight of 7.6 kg, with aortic coarctation and patent ductus arteriosus with a large left-to-right shunt who underwent successful simultaneous balloon angioplasty of native coarctation and coil embolization of the patent ductus arteriosus. Coarctation gradient decreased from 30 to 4 mmHg after balloon angioplasty and complete occlusion of the ductus arteriosus was achieved without any complication.     

The mucocutaneous manifestations associated with celiac disease in childhood and adolescence

This study was performed to detect the prevalence of mucocutaneous manifestations of celiac disease in childhood and adolescence and to investigate the relationship between these findings and duration of disease and a gluten-free diet. The study included 55 children and adolescents with a mean age of 10.0 +/- 4.61 years (2-19 years). Mucocutaneous manifestations were evaluated with respect to age, gender, duration of illness, and of gluten-free diet and compliance with this diet. Cutaneous, mucosal, nail, and hair findings were detected in 74.5%, 27.3%, 20.0%, and 7.3% of patients, respectively. The most prevalent dermatologic diagnosis was xerosis (69.1%). No significant relationship was detected between the cutaneous findings and the duration of illness (p > 0.05). However, the duration was longer in patients with mucosal findings compared to those without mucosal findings (p < 0.05). It was found that all patients without cutaneous findings were on a strict gluten-free diet (p < 0.05). Ours is one of the few studies describing skin findings in children with celiac disease. We believe that both pediatricians and dermatologists should be aware of the various mucocutaneous manifestations of celiac disease, because a careful skin, mucosa, nail, and hair examination may lead to a diagnosis of celiac disease, particularly in atypical presentations.     

Right pulmonary artery--left atrial communication presenting with brain abscess: a case report

Direct communication between the right pulmonary artery and left atrium is a very rare vascular malformation. We report a patient with this anomaly. She presented with unexplained cyanosis and brain abscesses. The diagnosis was made with contrast echocardiography and angiography. We treated this anomaly successfully with surgery. Complete cure for this anomaly can be achieved by ligation.     

Vascular rings and pulmonary artery sling: early and mid-term results of surgical correction

Background The great majority of patients with complete vascular rings and pulmonary artery sling present before their first birthday. This retrospective report summarises the surgical experience of a single institution with the majority of vascular ring group presenting after infancy and having associated congenital cardiac anomalies. Possible reasons of delayed presentation of vascular ring, the asymptomatic left pulmonary artery sling and the individualised surgical management of each subgroup are discussed. Methods Fifteen consecutive patients, aged 2 months to 9 years (mean±SD=41.33±31.55 months) underwent surgical correction of vascular rings and sling during the last 12 years, including one infant. All patients underwent chest roentgenogram, barium esophagogram, two dimensional echocardiogram and cardiac catheterisation. Magnetic resonance imaging was employed in three patients. Four patients with isolated complete vascular ring were symptomatic (group A), one patient with left pulmonary artery sling was asymptomatic (group B) and 10 symptomatic patients with complete vascular rings had associated congenital cardiac anomalies (group C). The operative approach was through a left posterolateral thoracotomy (n=5), a median sternotomy (n=8) and a combination of median sternotomy and left thoracotomy (n=2). Operations of various types were performed. Results The operative mortality was 6.6% and there was no late death. All survivors are doing well and asymptomatic after a mean follow up period of 66.87 months (range=1 month to 143 months). Postoperative barium esophagogram in all survivors revealed no stasis of contrast in the upper esophagus and marked diminution in the degree of esophageal indentations. Conclusions Accuracy in diagnosis is important to determine the optimal surgical approach. Individualization of surgical management provides gratifying results. Asymptomatic left pulmonary artery sling without associated anomalies may be left untreated.